摘要
目的总结腹股沟复发疝的临床特点,探讨其手术方式的选择。方法分析57例腹股沟复发疝患者的资料,其中接受网塞-平片疝修补术(Rutkow术)32例、平片式无张力疝修补术(Lichtenstein术)16例、腹腔镜下经腹腹膜前疝修补术(TAPP术)9例,分析所有患者复发疝临床特点,比较3种术式患者的年龄、复发部位、复发时间、复发次数、复发疝类型、手术时间、住院费用、住院时间、术后并发症等。结果 57例均为男性患者。患者腹股沟复发疝的高发年龄段为61~70岁、71~80岁,分别占总复发疝例数的22.8%和31.6%,术后1~5年内复发率占29.8%,右侧复发疝占54.4%。复发1次者55例(96.5%),复发2次者2例(3.5%)。3种术式患者的手术时间、住院时间比较差异无统计学意义(P均>0.05)。57例中存在并发症32例,包括血清肿20例、发热4例、切口液化渗出3例、尿潴留2例、暂时性神经感觉异常2例、皮下气肿1例,经对症支持治疗后均痊愈。术后中位随访时间41个月,Rutkow术术后1例复发,Lichtenstein术及TAPP术均无复发者。结论复发性腹股沟疝中老年男性、右侧疝更常见,Rutkow术、Lichtenstein术及TAPP术疗效相近,应根据患者情况按个体化原则选择术式。
Objective To summarize the clinical characteristics of recurrent inguinal hernia and investigate the selection of surgical approach. Methods Clinical data of 57 patients with recurrent inguinal hernia were retrospectively analyzed. Among them,32 cases received mesh-plug hernia repair（ Rutkow-Robbins technique）,16 patients underwent tension-free inguinal hernia repair（ Lichtenstein technique） and 9 cases received laparoscopic transabdominal peritoneal repair（ TAPP）. Clinical characteristics of the recurrent hernia in all patients were analyzed. Age,site,time and frequency of recurrence,type of recurrent hernia,operation time,hospitalization cost,length of hospital stay and postoperative complications were statistically compared among three groups. Results All 57 patients were male. The percentage of 61-70 year old patients with recurrent inguinal hernia was 22. 8%,and 31. 6% for those aged 71-80 years. The recurrence rate within postoperative 1-5 years was 29. 8%. The proportion of the recurrent hernia in the right side was 54. 4%. The inguinal hernia recurred once in 55 cases（ 96. 5%）,and twice in 2 patients（ 3. 5%）. The operation time and length of hospital stay did not significantly differ among three groups（ both P〉 0. 05）. Among 57 cases,32 patients presented with postoperative complications including seroma in 20,fever in 4,incisions with fat liquefaction in3,urinary retention in 2,temporary nerve sensory abnormalities in 2 and subcutaneous emphysema in 1. All these complications were healed after symptomatic treatment. The median time of postoperative follow-up was 41 months. One case recurred after Rutkow-Robbins technique. No patient recurred following Lichtenstein and TAPP techniques. Conclusions Recurrent inguinal hernia is more likely to recur in the right side of middleaged and elderly male patients. Rutkow-Robbins,Lichtenstein and TAPP techniques achive similar clinical efficacy. Surgical approach should be selected based upon the individualized conditions.
作者
张磊
汝磊
韩康
马小磊
Zhang Lei;Ru Lei;Han Kang;Ma Xiaolei(Department of General Surgery,the First People＇ s Hospital of Huainan City, Huainan 232007, Chin)
出处
《新医学》
2018年第5期369-373,共5页
Journal of New Medicine
